Nesiritide in acute decompensated heart failure: current status and future perspectives.
Acute decompensated heart failure (ADHF) is a growing public health problem with high mortality and costs. ADHF often, if not usually, occurs in the setting of cardiovascular and noncardiovascular comorbidities as well as advanced age. New insights provide support for the concept of heart failure as a state of deficiency of and/or resistance to endogenous B-type natriuretic peptide. The primary goals of ADHF therapy are to relieve symptoms and optimize volume status with minimal side effects. Few therapies are proven to effectively do so. Nesiritide is a balanced vasodilator with favorable neurohumoral effects and is superior to placebo in providing rapid symptom relief and to nitroglycerin in reducing filling pressures. Recent trials confirm a lack of renal toxicity at recommended doses. An adequately powered multinational mortality trial is underway. Nesiritide represents a proven therapy for normotensive/hypertensive ADHF patients with severe symptoms at rest.
Mohammed
Selma F
SF
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
Korinek
Josef
J
Chen
Horng H
HH
Burnett
John C
JC
Redfield
Margaret M
MM
D000208:Acute Disease; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D006333:Heart Failure / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D020097:Natriuretic Peptide, Brain / Q000009:adverse effects / Q000191:economics / Q000378:metabolism / Q000627:therapeutic use*; D018579:Patient Selection; D018570:Risk Assessment; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*
D000959:Antihypertensive Agents; D014665:Vasodilator Agents; D020097:Natriuretic Peptide, Brain